The Cause, Symptoms, and Treatment of the Tailor's Bunion

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Published: 12th January 2011
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Bunions are a well known and much reviled foot deformity involving a prominent big toe joint. The issues regarding pain in shoes and pressure on the prominent big toe joint are generally understood by the general public, and many people seek wider shoes or surgery to have this potentially painful deformity corrected. Of lesser 'fame', but no less important is the Tailor's bunion. This article will discuss this deformity, and how it can be treated.



The joint at the base of the little toe, called the 5th metatarsal phalangeal joint, is somewhat different than the joint at the base of the big toe, where a traditional bunion is located. Its anatomic function in sharing the weight of the body and propelling the foot during walking is different, so therefore its shape and structure will differ from the big toe joint on the other side of the foot. However, a similar deformity can occur generally for the same reasons bunions occur at the big toe joint, leading to pain and a prominent bone against the side of the shoe. In essence, a Tailor's bunion (also called a bunionette) is either an enlargement of the end of the 5th metatarsal bone outward against the side of the foot, or it is a spreading or bowing of this bone away from the foot, causing the same pressure. The result is pressure of the joint against the skin on the outside of the foot, on the exact opposite end of where a traditional bunion develops. Tight shoes will initially aggravate this site, causing skin irritation where the rubbing occurs. Eventually, the irritation will spread to the tissue underneath the skin, and a protective fluid bag called a bursa may develop to pad the surface between the skin and the prominent bone. In time, this bag itself may become inflamed, and the direct tissue covering the joint will follow suit, as an inflammatory condition called capsulitis develops. In advanced cases, pain and irritation can develop even in the absence of a shoe, simply with pressure from barefoot walking.



Traditional myth holds that the name 'Tailor's bunion' is derived from the way tailor's would sit and sew, with the feet cross-legged and underneath the body. In this position, the outside of the foot receives great pressure, and the little toe joint would therefore become irritated and inflamed after awhile. Certainly not seen only in tailors, this condition in actuality has its origins in genetics and foot structure. If one is born with a foot that is somewhat more flexible and mobile, the resulting excess motion will eventually lead to a migration of the 5th metatarsal bone away from the rest of the foot. The little toe, on the other hand, will migrate inward toward the toe next to it, leading to the prominent area on the outside of the little toe joint seen in a Tailor's bunion. If the foot is more stable structurally, a Tailor's bunion can still develop through a process of mechanical irritation on the bone itself as a enlargement or spur of the side of the bone slowly grows over time in some people. Tight shoes do not really cause this condition, but they certainly will encourage inflammation of the tissue over the bone, leading to pain and a definite awareness of the deformity if it was not noticed before.



Treatment for Tailor's bunions can be as simple as changing shoes to as complicated as reconstructive surgery. One of the first things that needs to be employed when treating this condition is to look at the shoes worn on a daily basis. The majority of the time when a Tailor's bunion is painful, these shoes will be narrow or pointed. Women's dress shoes, and certain types of men's dress shoes or reinforced boots will be in this category. Sometimes a simple conversion to a wider or more box-shaped shoe will alleviate all discomfort. In advanced cases, however, even roomier shoes will cause discomfort. This is mainly due to the inflammation occurring under the skin. In some cases, gel, foam, or felt padding can be used to help decrease joint pressure, although this tends to increase the 'bulk' of the foot in the shoe, and may have the opposite effect by making the shoe tighter. The inflammation itself can be treated with anti-inflammatory medications or injections, although these do not have any effect on the actual cause of structural irritation of the joint. In some cases, the use of prescription inserts (orthotics) can stabilize the 5th metatarsal, and limit the amount of instability, leading to a lessening of Tailor's bunion symptoms. Long term use of orthotics may even help limit the development of a Tailor's bunion outright, although use must begin at an early age.



In order to permanently correct a Tailor's bunion, and eliminate the shoe irritation from the equation, surgery is required. Surgery essentially involves removal of the bone prominence. How this is done can vary depending on the nature of the bone deformity. If the side of the bone is simply enlarged, the surgeon can shave the enlarged portion off and this will be enough to relieve the symptoms. Healing for this is relatively quick, with most patients returning to a regular shoe within a few weeks, and time off the foot is usually limited to only a few days after surgery. If the bone position is abnormal, and the 5th metatarsal is angled or bowed away from the foot, a procedure to return it to a correct position is required. During this surgery, the bone is cut and moved in such a way that the normal position is restored, and screws or wires are used to hold the bone down so the cut end can heal. Recovery takes six weeks on average, usually while in a walking boot, although some surgeons may prefer a cast in certain cases. Both these surgeries tend to be quite successful, and have low rates of significant complications.



While not as well known as a traditional bunion, a Tailor's bunion is nonetheless just as common, and can be just as painful. As one can see from this article, treatment options for this condition are available and can provide long lasting relief. It is yet another example of a foot condition that does not need to be suffered through for a lifetime.





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Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit the website of this Indianapolis foot doctor for more articles.

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